"Monday morning blues" where tolerance to nitrates develops with uninterrupted usage (folks exposed to nitrates throughout their work do not feel the side effects, but when they return on Monday, they feel the ADRs and thus feel "blue") usually presented as a worker in a munition factory (nitrate exposure)

Main ADRs of nitrates

Headache (problematic in that it reduces compliance), tachycardia, orthostatic hypotension

Methemoglobin system

Oxidation of Fe2+ to Fe3+, which helps bind nitrate species (like cyanide/CN) and reduce their toxicity

Erectile dysfunction and nitrates

Do NOT give Viagra (sildenAFIL; --AFIL), since these drugs inhibit the breakdown of cGMP and can cause hypotensive crisis

Prolongs the QT interval, causes dizziness, and causes headaches

Ranolazine

Describe the progression of Nytroglycerine metabolism in the liver and smooth muscle

"Monday morning blues" where tolerance to nitrates develops with uninterrupted usage (folks exposed to nitrates throughout their work do not feel the side effects, but when they return on Monday, they feel the ADRs and thus feel "blue") usually presented as a worker in a munition factory (nitrate exposure)

Main ADRs of nitrates

Headache (problematic in that it reduces compliance), tachycardia, orthostatic hypotension

Methemoglobin system

Oxidation of Fe2+ to Fe3+, which helps bind nitrate species (like cyanide/CN) and reduce their toxicity

Contraindications w/ Nitrates

Do NOT give Viagra (sindenafil; --AFIL) or other PDE5 inhibitors -> inhibit breakdown of cGMP and can cause fatal hypotension

Prolongs the QT interval, causes dizziness, and causes headaches

Ranolazine

Describe the progression of Nytroglycerine metabolism in the liver and smooth muscle